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National Diabetes Programmes

A Guide to National Diabetes Programmes

A National Diabetes Programme guide is currently in press. This builds on the 2003 NDP Toolbox and sets out considerations and source material for developing and implementing NDPs. Topics include measuring the problem (disease prevalence, morbidity and cost), intervening to mitigate the problem (prevention, early diagnosis, services and care of people with diabetes) and evaluating the impact of the interventions.

What is a National Diabetes Programme

A National Diabetes Programme is a systematic and co-ordinated approach to improving the organisation, accessibility, and quality of diabetes prevention and care which is usually manifest as a comprehensive policy, advocacy and action plan covering the:

Whole continuum of care from primary prevention to treatment and palliative care

Resources, services and systems that support prevention and care

Where lack of resources or political support preclude the development of a comprehensive National Diabetes Programme, single component or ‘stand alone’ programmes can raise awareness of diabetes, bring worthwhile gains and may be helpful in paving the way for a more comprehensive programme. Single component programmes may focus on:

One aspect of diabetes such as foot problems, visual impairment, kidney disease

One aspect of care such as clinical management guidelines, data collection workforce training

Regardless of whether they are comprehensive or single component, National Diabetes Programmes can be defined as formal strategies for improving diabetes policy, services and outcomes that encompass structured and integrated or linked activities which are planned and co-ordinated nationally and conducted at the national, state or district, and local level.

National Diabetes Programmes must be documented and have stated goals and objectives, supported by a strategic plan, specified timeframes and milestones and dedicated funding, and a means of evaluation. Approval and endorsement of, and leadership from the Ministry of Health is vital.

The core elements of a comprehensive national diabetes programme are:

Primary prevention ie preventing the development of risk factors

Secondary prevention ie preventing the development of diabetes

Tertiary prevention ie preventing the development of complications through early diagnosis and effective monitoring, treatment and care of people with diabetes

The funding and systems that underpin prevention and care ie:

workforce and services

medication, equipment and supplies

information and communication systems

monitoring and surveillance systems

clinical policy, guidelines and governance

resource allocation

Contents:

Section 1 - Getting Started

Making the Advocacy Case for Diabetes

Developing a Framework for a National Diabetes Programme

Establishing a National Diabetes Organisation

Section 2 - Determining the Extent of the Problem

Conducting a Situation and Needs Analysis

Conducting a Baseline Prevalence Survey

Assessing the Cost of Diabetes

Assessing Community Awareness

Section 3 - Preventing the Problem

The Individual or High Risk Approach

The Population / Environmental Approach

Section 4 - Addressing the Problem

Developing a Community Awareness Campaign

Early Diagnosis of type 2 Diabetes

Routine Care and Monitoring of Diabetes

Patient Education

Psychological Issues

Developing and Implementing Guidelines

Developing the Diabetes Workforce and Services

Section 5 - Evaluating Progress

Collecting Diabetes Data

Evaluating National Diabetes Programmes

Section 6 - Where to next?

National Diabetes Programmes of the future

Standards for National Diabetes Programmes

Section 7 - Who can help?

IDF Global Infrastructure

IDF Regional Infrastructure

IDF Task Force on Diabetes and NCD Prevention, Policy and Practice

Section 8 - Additional Information

Suggested Readings

Useful Definitions

The guide will be available shortly along with a PowerPoint presentation on key aspects of the Guide.

Standards for National Diabetes Programmes

In the interests of developing a common understanding and language around National Diabetes Programes at the global level, the IDF Task Force on Diabetes and NCD Prevention, Policy and Practice has developed an initial set of 10 core standards for National Diabetes Programmes.

A National Diabetes Programme exists and is publicly available

The goals and objectives of the National Diabetes Programmes are clearly documented

The National Diabetes Programme is endorsed and led or auspiced by the Ministry of Health

The National Diabetes Programme has been allocated dedicated funding by the Government

ensuring equitable access to prevention and care services for all who need them

workforce development

the provision of adequate services, equipment and supplies

information systems

clinical governance/ guidelines and protocols

There is a documented implementation plan for the National Diabetes Programme

An appropriately constituted steering committee or group is tasked with overseeing the implementation of the National Diabetes Programme. This should include a range of stakeholders eg:

government authorities/officials

specialists and Primary Health Care Workers

business leaders

community leaders

diabetes association, professional societies or, action groups

relevant national/international health organisations/agencies

The National Diabetes Programme takes a Patient Centred Approach ie:

people with diabetes are consulted about their needs

people with diabetes are represented on the committee responsible for the NDP implementation

the NDP includes a focus on ensuring equal access to health care regardless of geographic location, socio-economic status, language, culture or indigenous status

The National Diabetes Programme involves monitoring and surveillance of:

prevalence and incidence

access to and outcomes of routine clinical care and services

availability of essential medications and supplies

cost of diabetes to the health system/government

cost of diabetes to individuals/families or carers

community awareness

workforce: distribution, skills, numbers

Over time it is intended to refine and expand the standards and add measurable indicators by which national programmes can be assessed meaningfully and compared. If you have comments please send them to Maria Gomez.